If you have friends or relatives in care homes, or live in one yourself, you may be familiar with what is often the standard offer. Residents are kept behind locked doors, rarely granted a walk outside, instead stuck in armchairs in front of blaring televisions, surrounded by equipment redolent of medical rather than domestic spaces, deprived of the ability to make decisions about almost anything. A care home might be a big old house awkwardly converted, or a new-build as ruthlessly cost-efficient as a distribution centre or a budget hotel. Even where staff and management are genuinely committed to the wellbeing of residents (and there are reported instances where this is not the case), it seems hard to escape the pervasive deadening formula.
This, even if you are not yet old and don’t suffer from dementia, is something about which you should care, as the above is a future that could be coming for you. It’s an issue for society in general, as the population ages. It’s also an area where architecture has a role to play, as the physical environment can demonstrably improve or harm the wellbeing of residents. Done right, design can make the care of elderly people less stressful and more effective. It can reduce the need for expensive medical and other interventions.
For architects, who generally want to do more with their skills than adding some style to an office block or a private house, designing for older people and those living with age-related diseases such as dementia gives them a chance to contribute to something of social value. And so you get works such as the John Morden Centre in Blackheath, south-east London – a day care centre for residents of a retirement community by MAE Architects, winner of last year’s Stirling prize – and Appleby Blue in nearby Bermondsey, a “21st-century almshouse” by Witherford Watson Mann. With both projects, the architects went many extra miles to achieve such things as good daylight; strong senses of connection with the outside and between different parts of the building; materials that are natural and pleasurable; and corridors that, rather than functional thoroughfares, are enjoyable places to linger.
The Village Landais Alzheimer, on the edge of the town of Dax in south-west France, is a comprehensive attempt to “give real life back” to people with Alzheimer’s, as one staff member puts it, to “create conditions where they don’t just stay in a room waiting to die”. It is modelled on the Hogeweyk dementia village in the Netherlands, a celebrated 14-year-old facility with the look and layout of a village. The Dax project is similarly designed to have the life and appearance of a traditional community, with familiar and legible architecture based on features common in the region, albeit in simplified modern forms. There is a “bastide” – an arcaded square with a restaurant, library and other facilities – plus four clusters of homes, their roofs shallow-pitched and clay-tiled, around a pleasant green space, with a pond and trees in the middle.
The project is a self-declared experiment to test how its principles work in practice. It was initiated by the area’s local authority, the département des Landes, its €28m budget largely funded by them with some help from regional and national governments. It serves 108 residents (who pay €2,000 a month and can get assistance if they can’t afford this amount) plus 12 daycare patients, with more than 120 staff and 80 volunteers. It pays particular attention to the needs of people with early-onset dementia, which means that the ages of its current population range from 42 to 104. It was designed by the Danish practice Nord and local architects Champagnat & Grégoire.
Village Landais, which opened in 2020 and was recently highly commended in Dezeen’s annual design awards, aims to give as much agency and freedom, real and apparent, to the villagers, as the staff call them, as possible. The five-hectare complex has a fence around it, as it must for the safety of vulnerable residents, but within its boundary people can come and go, more or less as they choose. They can stroll around the open spaces (or run, or cycle, as people with Alzheimer’s can also be physically fit), visit their neighbours, go to the restaurant or to a show in the village auditorium, attend to animals and plants in a mini-farm and a kitchen garden.
Within each cluster of buildings, or quartier, are individual “houses”, each with private bedrooms and a shared sitting and dining area, and a kitchen run by staff. These in turn look through glass walls into informal courtyards, to create the possibility of community with the other houses. The courts are both sheltering and partly open, which gives a sense of flow from one to the next. The paths around the village are designed in loops, because people with Alzheimer’s sometimes get confused by dead ends. They also return walking routes back towards the centre and away from the boundary fence, which you barely notice. The idea is to create an “impression of liberty”, says Mathilde Charon-Burnel, who manages social care projects for the département.
There are other details designed to mitigate the effects of the disease. The paving is a uniform beige colour throughout, as strong contrasts can be disturbing to people with Alzheimer’s. Mirrors, also potentially unsettling, can be concealed by shutters. Light and dark are used to attract attention where it should go, and deflect it from where it should not. Pale door handles are placed against darker backgrounds, and doors to service areas are barely noticeable in boarded walls. People with Alzheimer’s are “more curious than other people, as they are lost all the time”, says Charon-Burnel, so “if you put a ‘no entry’ or ‘staff only’ sign on something they will go there”. It’s better to make the off-limits zones inconspicuous. “There is as little signage as possible,” says Morten Rask Gregersen of Nord. “People can see where they need to go instead of being shown.”
There’s also a make-believe shop, where villagers can “buy” products they don’t actually pay for, and a make-believe compartment of an old-fashioned railway carriage, with a screen inside that shows countryside scrolling by. Therapists use these to make patients think they really have been on a journey. You may think that such artifices would only add to their bewilderment, but I’m told that they calm and reassure the residents.
The Dax project and those in Blackheath and Bermondsey serve different degrees and kinds of need. Appleby Blue is sheltered housing, which offers residents more independence than is possible in an Alzheimer’s village. But the projects share the desire to respect the individuality and dignity of the people who live in them, a recognition that you continue to be the person you were when you were younger. Also in this category is Bankhouse in Vauxhall, south London, run by Tonic housing association, a retirement community for LGBTQ+ people in a riverside tower designed by Foster + Partners. Here, residents are offered not just dwelling units but shared facilities – art classes, a bar, a roof garden – that help to create a community.
Dignity includes visibility. It’s a weird feature of many care homes that passersby almost never see the residents through their hermetic exteriors or in their deserted gardens, as if ageing is something that should be kept from view. In Appleby Blue the communal areas are right next to a street and a bus stop, their upper floor on a level with the top deck of a doubledecker, with generous windows allowing convivial views in both directions. The Dax village is more secluded, but its auditorium and library are accessible to the local community.
Most importantly, these projects appear to work. In Dax, the villagers seem cheerful, engaged, relaxed. I meet a couple who got together after they moved there, who urge me to come back when the weather is better and the flowers are out. Charon-Burnel tells me that lower levels of anxiety create fewer “behaviour issues”, which makes the carers’ jobs easier. More scientifically, independent research recently found that markers for such things as cognitive decline and depression were significantly better in the Dax village than in other care homes.
The most obvious challenge is that of scale. The number of people with Alzheimer’s in France is around 1 million, not to mention other forms of dementia, so it would take a lot of projects such as Village Landais to make an impact. But the principles of agency and respect are at least exportable to less singular situations. The alternative is not only avoidable misery for older people but also increased spending on the health problems that come with it. Why wouldn’t any of us want happier, healthier places for people nearing the end of their life, especially as many of us will end up in one ourselves?
